VACCINE

Vaccine • September 2014
Interaction between neonatal vitamin A supplementation
and timing of measles vaccination:
a retrospective analysis of three randomized trials
from Guinea-Bissau
Author information
Benn CS1, Martins CL2, Fisker AB3, Diness BR3,
Garly ML3, Balde I2, Rodrigues A2, Whittle H4, Aaby P5.
1. Research Center for Vitamins and Vaccines (CVIVA)
Bandim Health Project, Artillerivej 5, 2300 Copenhagen S, Denmark
Institute of Clinical Research
University of Southern Denmark/Odense University Hospital, Denmark
cb@ssi.dk.
2. Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
3. Research Center for Vitamins and Vaccines (CVIVA)
Bandim Health Project, Artillerivej 5, 2300 Copenhagen S, Denmark
4. The London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
5. Research Center for Vitamins and Vaccines (CVIVA)
Bandim Health Project, Artillerivej 5, 2300 Copenhagen S, Denmark
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
Abstract
BACKGROUND
In Guinea-Bissau we conducted three trials of neonatal vitamin A supplementation
(NVAS) from 2002 to 2008. None of the trials found a beneficial effect on mortality.
From 2003 to 2007, an early measles vaccine (MV) trial was ongoing, randomizing
children 1:2 to early MV at 4.5 months or no early MV, in addition to the usual MV at 9
months. We have previously found interactions between vitamin A and vaccines.
OBJECTIVE
We investigated whether there were interactions between NVAS and early MV.
DESIGN
We compared the mortality of NVAS and placebo recipients: first, from 4.5 to 8 months
for children randomized to early MV or no early MV; and second, from 9 to 17 months
in children who had received two MV or one MV. Mortality rates (MR) were compared
in Cox models producing mortality rate ratios (MRR).
RESULTS
A total of 5141 children were randomized to NVAS (N=3015) or placebo (N=2126)
and were later randomized to early MV (N=1700) or no early MV (N=3441). Between
4.5 and 8 months, NVAS compared with placebo was associated with higher mortality
in early MV recipients (MR=30 versus MR=0, p=0.01), but not in children who did
not receive early MV (p for interaction between NVAS and early MV=0.03). From 9
to 17 months NVAS was not associated with mortality. Overall, from 4.5 to 17 months
NVAS was associated with increased mortality in early MV recipients (Mortality rate
ratio=5.39 (95% confidence interval: 1.62, 17.99)).
CONCLUSIONS
These observations indicate that NVAS may interact with vaccines given several
months later. This may have implications for the planning of future child intervention
programs.
http://www.ncbi.nlm.nih.gov/pubmed/25131735
“These observations
indicate that neonatal
vitamin A supplementation
may interact with vaccines
given several months later.”